The overarching goal of the "Alcoa Study" is to explain the disparate health and work- capacity trajectories demonstrated in this cohort of 40,000+ men and women as they progress from work-life into retirement. Outcomes of focus are incident chronic disease, work-disability and mortality. Etiologic factors of interest include 1) pre-employment health trajectories;2) adult health behaviors;3) work status and economic rewards;3) workload, including physical demands, hours and shifts;5) physical environmental hazards of work;6) psychosocial characteristics of work and work organization;7) health care quality and utilization;and 8) impacts of extrinsic factors such as economic cycles, changes in work benefits and policy interventions. This application builds on 5 years of investment in infrastructure development and initial analyses across each of the relevant outcome domains. Key observations include: 1. Both physical and psychosocial environment in the workplace contribute to risk for development of chronic disease and disability. 2. Pre-employment and post-employment regional and personal selection factors confound associations between work factors and health outcomes;methods to manage this remain inadequate. 3. Physical and psychological work demands are more salient risks in this population than in well studied white-collar populations;work "control" is less so. 4. The industrial workplace appears to impact women more unfavorably than men in terms of both disease incidence and disability. 5. Despite uniform access to health services for the whole population in each area, health care quality is strongly associated with SES, and with better outcomes independent of SES and other (measurable) underlying risks. 6. Time-varying external events, such as down turns in the business cycle and changes in benefits impact health and work capacity in this population. We propose some additional data collection and new models that will ultimately 1) lead to identification of opportunities for intervention in the workplace or in policy, and 2) best exploit our relative advantages among ongoing studies of these issues such as Whitehall and the Health and Retirement Study. PUBLIC HEALTH RELEVANCE: Most of the serious chronic diseases that afflict Americans, like diabetes and heart disease, start in mid-life. Many become serious enough to limit or curtail the ability to work, especially for poorer and middle class people. The overarching goal of this study is to better understand what aspects of their lives during that period contribute to diseases and disability- Something about work and the workplace? Something about personal behavior? Something about position in society? Something about doctors and healthcare? We are especially looking for those things about work and that could be fixed if we understood them better.